Provider Demographics
NPI:1215527676
Name:DEAN, WESLEY (PA-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9651
Mailing Address - Country:US
Mailing Address - Phone:231-587-9181
Mailing Address - Fax:213-587-0923
Practice Address - Street 1:419 W STATE ST
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-9651
Practice Address - Country:US
Practice Address - Phone:231-587-9181
Practice Address - Fax:213-587-0923
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant